Upwork Medical Billing Certification Skill Test Questions
Question: 01
Which are the disclosures exempted from minimum necessary?
a.Permissive Disclosures
b.Disclosure of Protected Health Information
c.Disclosure of de-identified information
d.None of the above
Question: 02
Which of the following components of HIPAA have been put into effect?
a.Portability and Administrative Simplification
b.Portability and Accountability
c.Accountability and Program
d.Administrative Simplification and Program
Question: 03
What things should you emphasize on while selecting an attorney when starting your own medical billing business?
a.You should look at his years of experience
b.He should be able to develop a Compliance Plan in accordance with HIPAA protocols
c.You should look at the attorney’s ability to speak legal jargon with you
d.You should look at his knowledge base about the entire legal system of your country
Question: 04
What is a covered entity?
a.Any private organization or a government agency
b.The organizations which maintain and upgrade ICD-9-CM codes
c.The healthcare providers which are linked to PPOs
d.The healthcare bodies covered by HIPAA
Question: 05
What is needed to file Worker’s Compensation and Auto Insurance Claims?
a.Patient Relationship to Insured
b.Patient’s Name
c.Patient Address & Telephone Number
d.Claim Number
Question: 06
Which of the following aspects does administrative safeguards focus on?
a.Administrative functions that ought to be applied to meet security standards
b.Methods that should be applied to meet physical standards
c.Administrative functions that prevent access to technical data
d.All of the above
Question: 07
Which of these does not cover preventive care services?
a.POS
b.PPOs
c.HMOs
d.None of the above
Question: 08
What does the bottom of the CMS 1500 Form report?
a.Provider
b.Procedure
c.Diagnostic and Charge Information
d.All of the above
e.None of the above
Question: 09
What is a deductible?
a.A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year
b.The percentage that the policy will pay for a covered procedure
c.The percentage that the policy will pay for diagnostic, lab and x-ray procedures
d.The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%
Question: 10
Which of the following is not necessarily a function performed by a medical biller?
a.Performing insurance benefits verification and referral tasks
b.Abstracting and coding of services rendered from a patient’s medical records
c.Submitting claims on Electronic Data Interchange (EDI)
d.Mailing patient’s billing statements
Question: 11
What is not one of the eligibility criteria for Medicare?
a.You should be 65 or more than 65 years of age
b.You should have retired on Social Security, Railroad Retirement, or federal government retirement programs
c.It is meant for individuals who have been legally disabled for more than 2 years or who are suffering from end-stage renal disease
d.You should be a resident of the United States
Question: 12
Which of the following is the first phase of the insurance claim life cycle?
a.Entering the data about claim information
b.Entering patient demographics in the claim form
c.Collecting claim data
d.Stating the name of the guarantor in the claim form
Question: 13
What do the CPT codes refer to?
a.The disease that the patient is suffering from
b.The diagnoses performed on the patient
c.The procedures performed by a physician or a practitioner
d.The names of the medicines prescribed by the practitioner
Question: 14
In which box are the CPT codes entered on the CMS-1500 Form?
a.Box 24A
b.Box 24D
c.Box 24B
d.Box 24C
Question: 15
What is an accident rider?
a.A 100% coverage that is not subject to co-payment or deductible in the event that the patient seeks emergency treatment
b.The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%
c.The remaining deductible amount not yet incurred by the insured party or family
d.A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year
Question: 16
Who among the following can also be a guarantor?
a.The patient
b.The physician
c.The insurance company
d.The medical biller
Question: 17
Electronic Medical Claims (EMC) help to ___________?
a.get the carrier more quickly than the paper claims
b.pay more quickly than the paper claims
c.notify more quickly in case the claim is rejected
d.All of the above
Question: 18
The component ‘National Identifier Standards’ fall under which of the following components of HIPAA?
a.Program
b.Administrative Simplification
c.Accountability
d.Portability
Question: 19
Which body is responsible for implementing the Privacy Rules?
a.The Office of Civil Rights
b.The American Medical Association
c.World Health Organization
d.All of the above
Question: 20
State whether true or false: Ideal practice management software should have good reporting and multi-tasking capabilities.
a.True
b.False
Question: 21
What does the UB-04 form include?
a.National Provider Identifier
b.Taxonomy
c.Guarantor Information
d.Additional Codes
Question: 22
What is the need for insurance verification?
a.To determine the accuracy of the patient information and the insurance card
b.To determine how the insurance will consider and/or pay for the services rendered
c.To charge the patient for their portion appropriately
d.To make the patient’s information public
Question: 23
Which of these is not a suitable marketing strategy for medical billing business?
a.Door-to-door marketing
b.Cold Calling
c.Mailing List
d.Business Networking
Question: 24
What is the role of a clearing house while submitting claims electronically?
a.A clearing house acts as an intermediary between the billing center and the insurance carrier
b.A clearing house allows the billing center to correct the errors in the rejected claim only once
c.A clearing house posts the final payments to the referring physician’s clinic
d.A clearing house performs an initial computerized review of the claim submitted and sends the claim to the insurance carrier
Question: 25
Which of the following is not a feature of Managed Care Plans?
a.Charging a nominal fee from the members
b.Eradicating unwanted services
c.Charging a standard fee for healthcare provider and hospital services
d.Itemizing each service and charging to the patient’s account
Question: 26
What is the full form of AIDA?
a.Attention, Interest, Desire And Action
b.Action, Interest, Desire And Advertising
c.Action, Interest, Desire And Attention
d.None of the above
Question: 27
_____is an agreement made between the insurance company and the insured to send payments directly to the physician.
a.Assignment of Benefits
b.Coordination of Benefits
c.Preauthorization
d.Pre-Existing Conditions
Question: 28
What are modifiers?
a.They are used to add more information about a ICD-9 CM code
b.They help in establishing “medical necessity”
c.They are used to add more information about a CPT code
d.They are an indicator to show that a procedure is linked to more than one diagnosis
Question: 29
Which of these is not one of the co-operating parties which maintains and upgrades ICD-9-CM codes?
a.World Health Organization(WHO)
b.American Hospital Association (AHA)
c.HCFA
d.National Center for Health Statistics
Question: 30
Which of the following correctly defines the Encounter Document?
a.It is a form consisting of patient demographics, patient condition and guarantor information
b.It is a form listing the present diagnosis and the past medical condition of the patient
c.It is a form listing the insurance coverage information of a patient
d.It is a form listing the services performed on a patient in a date of service
Question: 31
Which of the following does the acronym HIPAA stand for?
a.Health Insurance Program and Accountability Act of 1996
b.Health Insurance Portability and Accountability Act of 1996
c.Health Insurance Portability, Accountability, and Administrative Act of 1995
d.Health Insurance Portability and Administrative Act of 1995
Question: 32
What is contained in the release of information (ROI) form?
a.Name and signature of the patient
b.The details of the information being transmitted
c.The name of the medical biller
d.None of the above
Question: 33
In which of the following methods will you bill your clients for giving your services as a medical biller?
a.By using a set fee
b.By billing on a percentage of the claims submitted
c.By percentage of collections
d.All of the above
Question: 34
What is a write off?
a.It is a percentage of the charge or the dollar amount that the patient will pay to the provider for every encounter/visit
b.It is the difference between the actual fee and the permitted fee
c.It is the denial of a claim
d.It is the ongoing fee paid to the insurance company by the insured
Question: 35
Which date format is used on the CMS 1500 Form?
a.mm/dd/ccyy
b.mm/dd/yy
c.yy/mm/dd
d.The date is not required
Question: 36
The ‘Group’ in the ‘Group Health Insurance Card’ refers to the _________?
a.employer
b.the name of the insured
c.the name of the insurance company
d.third party administrator
Question: 37
What is the length of the standard CPT codes?
a.7
b.4
c.5
d.2
Question: 38
Which of these is not a type of insurance coverage?
a.Medicare
b.Group Health/Medical Insurance
c.Workers Compensation
d.Campus
e.Medical
Question: 39
Which of the following is not a part of Patient Condition Information?
a.Name and UPIN of the physician that was referred
b.Patient date of birth
c.Diagnosis information
d.Insured ID Number
Question: 40
If the patient deductible is $600, and the deductible met is $400, the coverage is 60/40 and the physician’s charge is $95, how much should the patient pay?
a.$200
b.$95
c.$360
d.$240
Which are the disclosures exempted from minimum necessary?
a.Permissive Disclosures
b.Disclosure of Protected Health Information
c.Disclosure of de-identified information
d.None of the above
Question: 02
Which of the following components of HIPAA have been put into effect?
a.Portability and Administrative Simplification
b.Portability and Accountability
c.Accountability and Program
d.Administrative Simplification and Program
Question: 03
What things should you emphasize on while selecting an attorney when starting your own medical billing business?
a.You should look at his years of experience
b.He should be able to develop a Compliance Plan in accordance with HIPAA protocols
c.You should look at the attorney’s ability to speak legal jargon with you
d.You should look at his knowledge base about the entire legal system of your country
Question: 04
What is a covered entity?
a.Any private organization or a government agency
b.The organizations which maintain and upgrade ICD-9-CM codes
c.The healthcare providers which are linked to PPOs
d.The healthcare bodies covered by HIPAA
Question: 05
What is needed to file Worker’s Compensation and Auto Insurance Claims?
a.Patient Relationship to Insured
b.Patient’s Name
c.Patient Address & Telephone Number
d.Claim Number
Question: 06
Which of the following aspects does administrative safeguards focus on?
a.Administrative functions that ought to be applied to meet security standards
b.Methods that should be applied to meet physical standards
c.Administrative functions that prevent access to technical data
d.All of the above
Question: 07
Which of these does not cover preventive care services?
a.POS
b.PPOs
c.HMOs
d.None of the above
Question: 08
What does the bottom of the CMS 1500 Form report?
a.Provider
b.Procedure
c.Diagnostic and Charge Information
d.All of the above
e.None of the above
Question: 09
What is a deductible?
a.A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year
b.The percentage that the policy will pay for a covered procedure
c.The percentage that the policy will pay for diagnostic, lab and x-ray procedures
d.The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%
Question: 10
Which of the following is not necessarily a function performed by a medical biller?
a.Performing insurance benefits verification and referral tasks
b.Abstracting and coding of services rendered from a patient’s medical records
c.Submitting claims on Electronic Data Interchange (EDI)
d.Mailing patient’s billing statements
Question: 11
What is not one of the eligibility criteria for Medicare?
a.You should be 65 or more than 65 years of age
b.You should have retired on Social Security, Railroad Retirement, or federal government retirement programs
c.It is meant for individuals who have been legally disabled for more than 2 years or who are suffering from end-stage renal disease
d.You should be a resident of the United States
Question: 12
Which of the following is the first phase of the insurance claim life cycle?
a.Entering the data about claim information
b.Entering patient demographics in the claim form
c.Collecting claim data
d.Stating the name of the guarantor in the claim form
Question: 13
What do the CPT codes refer to?
a.The disease that the patient is suffering from
b.The diagnoses performed on the patient
c.The procedures performed by a physician or a practitioner
d.The names of the medicines prescribed by the practitioner
Question: 14
In which box are the CPT codes entered on the CMS-1500 Form?
a.Box 24A
b.Box 24D
c.Box 24B
d.Box 24C
Question: 15
What is an accident rider?
a.A 100% coverage that is not subject to co-payment or deductible in the event that the patient seeks emergency treatment
b.The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%
c.The remaining deductible amount not yet incurred by the insured party or family
d.A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year
Question: 16
Who among the following can also be a guarantor?
a.The patient
b.The physician
c.The insurance company
d.The medical biller
Question: 17
Electronic Medical Claims (EMC) help to ___________?
a.get the carrier more quickly than the paper claims
b.pay more quickly than the paper claims
c.notify more quickly in case the claim is rejected
d.All of the above
Question: 18
The component ‘National Identifier Standards’ fall under which of the following components of HIPAA?
a.Program
b.Administrative Simplification
c.Accountability
d.Portability
Question: 19
Which body is responsible for implementing the Privacy Rules?
a.The Office of Civil Rights
b.The American Medical Association
c.World Health Organization
d.All of the above
Question: 20
State whether true or false: Ideal practice management software should have good reporting and multi-tasking capabilities.
a.True
b.False
Question: 21
What does the UB-04 form include?
a.National Provider Identifier
b.Taxonomy
c.Guarantor Information
d.Additional Codes
Question: 22
What is the need for insurance verification?
a.To determine the accuracy of the patient information and the insurance card
b.To determine how the insurance will consider and/or pay for the services rendered
c.To charge the patient for their portion appropriately
d.To make the patient’s information public
Question: 23
Which of these is not a suitable marketing strategy for medical billing business?
a.Door-to-door marketing
b.Cold Calling
c.Mailing List
d.Business Networking
Question: 24
What is the role of a clearing house while submitting claims electronically?
a.A clearing house acts as an intermediary between the billing center and the insurance carrier
b.A clearing house allows the billing center to correct the errors in the rejected claim only once
c.A clearing house posts the final payments to the referring physician’s clinic
d.A clearing house performs an initial computerized review of the claim submitted and sends the claim to the insurance carrier
Question: 25
Which of the following is not a feature of Managed Care Plans?
a.Charging a nominal fee from the members
b.Eradicating unwanted services
c.Charging a standard fee for healthcare provider and hospital services
d.Itemizing each service and charging to the patient’s account
Question: 26
What is the full form of AIDA?
a.Attention, Interest, Desire And Action
b.Action, Interest, Desire And Advertising
c.Action, Interest, Desire And Attention
d.None of the above
Question: 27
_____is an agreement made between the insurance company and the insured to send payments directly to the physician.
a.Assignment of Benefits
b.Coordination of Benefits
c.Preauthorization
d.Pre-Existing Conditions
Question: 28
What are modifiers?
a.They are used to add more information about a ICD-9 CM code
b.They help in establishing “medical necessity”
c.They are used to add more information about a CPT code
d.They are an indicator to show that a procedure is linked to more than one diagnosis
Question: 29
Which of these is not one of the co-operating parties which maintains and upgrades ICD-9-CM codes?
a.World Health Organization(WHO)
b.American Hospital Association (AHA)
c.HCFA
d.National Center for Health Statistics
Question: 30
Which of the following correctly defines the Encounter Document?
a.It is a form consisting of patient demographics, patient condition and guarantor information
b.It is a form listing the present diagnosis and the past medical condition of the patient
c.It is a form listing the insurance coverage information of a patient
d.It is a form listing the services performed on a patient in a date of service
Question: 31
Which of the following does the acronym HIPAA stand for?
a.Health Insurance Program and Accountability Act of 1996
b.Health Insurance Portability and Accountability Act of 1996
c.Health Insurance Portability, Accountability, and Administrative Act of 1995
d.Health Insurance Portability and Administrative Act of 1995
Question: 32
What is contained in the release of information (ROI) form?
a.Name and signature of the patient
b.The details of the information being transmitted
c.The name of the medical biller
d.None of the above
Question: 33
In which of the following methods will you bill your clients for giving your services as a medical biller?
a.By using a set fee
b.By billing on a percentage of the claims submitted
c.By percentage of collections
d.All of the above
Question: 34
What is a write off?
a.It is a percentage of the charge or the dollar amount that the patient will pay to the provider for every encounter/visit
b.It is the difference between the actual fee and the permitted fee
c.It is the denial of a claim
d.It is the ongoing fee paid to the insurance company by the insured
Question: 35
Which date format is used on the CMS 1500 Form?
a.mm/dd/ccyy
b.mm/dd/yy
c.yy/mm/dd
d.The date is not required
Question: 36
The ‘Group’ in the ‘Group Health Insurance Card’ refers to the _________?
a.employer
b.the name of the insured
c.the name of the insurance company
d.third party administrator
Question: 37
What is the length of the standard CPT codes?
a.7
b.4
c.5
d.2
Question: 38
Which of these is not a type of insurance coverage?
a.Medicare
b.Group Health/Medical Insurance
c.Workers Compensation
d.Campus
e.Medical
Question: 39
Which of the following is not a part of Patient Condition Information?
a.Name and UPIN of the physician that was referred
b.Patient date of birth
c.Diagnosis information
d.Insured ID Number
Question: 40
If the patient deductible is $600, and the deductible met is $400, the coverage is 60/40 and the physician’s charge is $95, how much should the patient pay?
a.$200
b.$95
c.$360
d.$240
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